Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases

View More View Less
  • 1 Service of Endovascular Therapy, University of California School of Medicine, Los Angeles, California
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ The authors describe their experience with 101 cerebral arteriovenous malformations (AVM's) treated by endovascular embolization followed by surgical removal. Fifty-three patients presented with intracranial hemorrhage and 35 had seizures. Based on the classification of Spetzler and Martin, two AVM's were Grade I, 13 were Grade II, 26 were Grade III, 43 were Grade IV, and 17 were Grade V, Fifty-six AVM's were in the right hemisphere, 28 were in the left hemisphere, 12 were in the corpus callosum, and five involved the cerebellum. In 50 cases, presurgical obliteration of 50% to 75% of the AVM nidus was achieved by embolization, and in 31 cases this percentage increased to between 75% and 90%. In 97 (96%) patients, complete surgical removal of the AVM was obtained.

Morbidity resulting from preoperative endovascular embolization was classified as mild in 3.9% of the cases, moderate in 6.9%, and severe in 1.98%. The death rate related to embolization was 0.9%. The immediate postsurgical morbidity was classified as mild in 5.9% of the cases, moderate in 10.8%, and severe in 5.9%. The overall long-term morbidity was mild in 5.9% of the cases, moderate in 6.9%, and severe in 1.98%. Two patients (1.98%) died due to intractable intraoperative hemorrhage and two (1.98%) as a result of postsurgical pulmonary complications.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address for Dr. Dion: University of Virginia, Charlottesville, Virginia.Address for Dr. Lylyk: Instituto de Investigaciones Neurologicas Raul Carrea, ENERI-Neurosurgery, 2039 Billinghurst-PBA, Buenas Aires, Argentina.Address for Drs. Fox, Pelz, Drake, and Girvin: University of Western Ontario, London, Ontario, Canada.Address for Dr. Debrun: Johns Hopkins Hospital, Baltimore, Maryland.Address reprint requests to: Fernando Viñuela, M.D., Service of Endovascular Therapy, University of California School of Medicine, 10833 Le Conte Avenue, Los Angeles, California 90024.
  • 1.

    Andrews BT, & Wilson CB: Staged treatment of arteriovenous malformations of the brain. Neurosurgery 21:314323, 1987 Andrews BT, Wilson CB: Staged treatment of arteriovenous malformations of the brain. Neurosurgery 21:314–323, 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Cromwell LD, & Harris AB: Treatment of cerebral arteriovenous malformations. A combined neurosurgical and neuroradiological approach. J Neurosurg 52:705708, 1980 Cromwell LD, Harris AB: Treatment of cerebral arteriovenous malformations. A combined neurosurgical and neuroradiological approach. J Neurosurg 52:705–708, 1980

    • Search Google Scholar
    • Export Citation
  • 3.

    Debrun G, , Lacour P, & Caron JP, et al: Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions. J Neurosurg 49:635649, 1978 Debrun G, Lacour P, Caron JP, et al: Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions. J Neurosurg 49:635–649, 1978

    • Search Google Scholar
    • Export Citation
  • 4.

    Dion JE, , Vinuela F, & Lylyk P, et al: Ivalon-33% ethanolavitene embolic mixture: clinical experience with neuroradiological endovascular therapy in 40 arteriovenous malformations. AJNR 9:1029, 1988 (Abstract) Dion JE, Vinuela F, Lylyk P, et al: Ivalon-33% ethanolavitene embolic mixture: clinical experience with neuroradiological endovascular therapy in 40 arteriovenous malformations. AJNR 9:1029, 1988 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 5.

    Drake CG: Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 26:145208, 1979 Drake CG: Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 26:145–208, 1979

    • Search Google Scholar
    • Export Citation
  • 6.

    Eskridge JM, & Harding RP: Preoperative embolization of brain AVMs using surgical silk and polyvinyl alcohol. AJNR 10:882, 1989 (Abstract) Eskridge JM, Harding RP: Preoperative embolization of brain AVMs using surgical silk and polyvinyl alcohol. AJNR 10:882, 1989 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 7.

    Halbach VV, , Higashida RT, & Yang P, et al: Preoperative balloon occlusion of arteriovenous malformations. Neurosurgery 22:301308, 1988 Halbach VV, Higashida RT, Yang P, et al: Preoperative balloon occlusion of arteriovenous malformations. Neurosurgery 22:301–308, 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Heros RC, , Korosue K, & Diebold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570578, 1990 Heros RC, Korosue K, Diebold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570–578, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Hilal SK, , Khandji AG, & Chi LT, et al: Synthetic fiber-coated platinum coils successfully used for the endovascular treatment of arteriovenous malformations, aneurysms and direct arteriovenous fistulas of the CNS. AJNR 9:1030, 1988 (Abstract) Hilal SK, Khandji AG, Chi LT, et al: Synthetic fiber-coated platinum coils successfully used for the endovascular treatment of arteriovenous malformations, aneurysms and direct arteriovenous fistulas of the CNS. AJNR 9:1030, 1988 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 10.

    Kerber C: Balloon catheter with a calibrated leak. A new system for superselective angiography and occlusive catheter therapy. Radiology 120:547550, 1976 Kerber C: Balloon catheter with a calibrated leak. A new system for superselective angiography and occlusive catheter therapy. Radiology 120:547–550, 1976

    • Search Google Scholar
    • Export Citation
  • 11.

    Kunc Z: Surgery of arteriovenous malformations in the speech and motor-sensorv regions. J Neurosurg 0:293303, 1974 Kunc Z: Surgery of arteriovenous malformations in the speech and motor-sensorv regions. J Neurosurg 0:293–303, 1974

    • Search Google Scholar
    • Export Citation
  • 12.

    Luessenhop AJ, & Rosa L: Cerebral arteriovenous malformations. Indications for and results of surgery, and the role of intravascular techniques. J Neurosurg 60:1422, 1984 Luessenhop AJ, Rosa L: Cerebral arteriovenous malformations. Indications for and results of surgery, and the role of intravascular techniques. J Neurosurg 60:14–22, 1984

    • Search Google Scholar
    • Export Citation
  • 13.

    Ojemann G, , Ojemann J, & Lettich E, et al: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:316326, 1989 Ojemann G, Ojemann J, Lettich E, et al: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:316–326, 1989

    • Search Google Scholar
    • Export Citation
  • 14.

    Pelz DM, , Fox AJ, & Viñuela F, et al: Preoperative embolization of brain AVMs with isobutyl-2 cyanoacrylate. AJNR 9:757764, 1988 Pelz DM, Fox AJ, Viñuela F, et al: Preoperative embolization of brain AVMs with isobutyl-2 cyanoacrylate. AJNR 9:757–764, 1988

    • Search Google Scholar
    • Export Citation
  • 15.

    Pevsner PJ: Micro-balloon catheter for superselective angiography and therapeutic occlusion. AJR 128:225230, 1977 Pevsner PJ: Micro-balloon catheter for superselective angiography and therapeutic occlusion. AJR 128:225–230, 1977

    • Search Google Scholar
    • Export Citation
  • 16.

    Purdy PD, , Samson D, & Batjer HH, et al: Preoperative embolization of cerebral arteriovenous malformations with polyvinyl alcohol particles: experience in 51 adults. AJNR 11:501510, 1990 Purdy PD, Samson D, Batjer HH, et al: Preoperative embolization of cerebral arteriovenous malformations with polyvinyl alcohol particles: experience in 51 adults. AJNR 11:501–510, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Rauch R, , Vinuela F, & Dion J, et al: Preembolization functional evaluation in brain AVMs: the ability of superselective Amytal test to predict neurologic dysfunction before embolization. AJNR (In press) Rauch R, Vinuela F, Dion J, et al: Preembolization functional evaluation in brain AVMs: the ability of superselective Amytal test to predict neurologic dysfunction before embolization. AJNR (In press)

    • Search Google Scholar
    • Export Citation
  • 18.

    Scialfa G, & Scotti G: Superselective injection of polyvinyl alcohol microemboli for the treatment of cerebral arteriovenous malformations. AJNR 6:957960, 1985 Scialfa G, Scotti G: Superselective injection of polyvinyl alcohol microemboli for the treatment of cerebral arteriovenous malformations. AJNR 6:957–960, 1985

    • Search Google Scholar
    • Export Citation
  • 19.

    Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125145, 1974 Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125–145, 1974

    • Search Google Scholar
    • Export Citation
  • 20.

    Spetzler RF, & Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476483, 1986 Spetzler RF, Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483, 1986

    • Search Google Scholar
    • Export Citation
  • 21.

    Spetzler RF, , Martin NA, & Carter LP, et al: Surgical management of large AVM's by staged embolization and operative excision. J Neurosurg 67:1728, 1987 Spetzler RF, Martin NA, Carter LP, et al: Surgical management of large AVM's by staged embolization and operative excision. J Neurosurg 67:17–28, 1987

    • Search Google Scholar
    • Export Citation
  • 22.

    Stein BM: Arteriovenous malformations of the medial cerebral hemisphere and the limbic system. J Neurosurg 60:2331, 1984 Stein BM: Arteriovenous malformations of the medial cerebral hemisphere and the limbic system. J Neurosurg 60:23–31, 1984

    • Search Google Scholar
    • Export Citation
  • 23.

    Steinmeier R, , Schramm J, & Müller HG, et al: Evaluation of prognostic factors in cerebral arteriovenous malformations. Neurosurgery 24:193200, 1989 Steinmeier R, Schramm J, Müller HG, et al: Evaluation of prognostic factors in cerebral arteriovenous malformations. Neurosurgery 24:193–200, 1989

    • Search Google Scholar
    • Export Citation
  • 24.

    Viñuela F: Endovascular therapy of brain arteriovenous malformations. Semin Intervent Radiol 4:12331238, 1983 Viñuela F: Endovascular therapy of brain arteriovenous malformations. Semin Intervent Radiol 4:1233–1238, 1983

    • Search Google Scholar
    • Export Citation
  • 25.

    Vinuela F, , Fox AJ, & Debrun G, et al: Preembolization superselective angiography: role in the treatment of brain arteriovenous malformations with isobutyl-2 cyanoacrylate. AJNR 5:765769, 1984 Vinuela F, Fox AJ, Debrun G, et al: Preembolization superselective angiography: role in the treatment of brain arteriovenous malformations with isobutyl-2 cyanoacrylate. AJNR 5:765–769, 1984

    • Search Google Scholar
    • Export Citation
  • 26.

    Viñuela F, , Fox AJ, & Pelz D, et al: Angiographic follow-up of large cerebral AVMs incompletely embolized with isobutyl-2-cyanoacrylate. AJNR 7:919925, 1986 Viñuela F, Fox AJ, Pelz D, et al: Angiographic follow-up of large cerebral AVMs incompletely embolized with isobutyl-2-cyanoacrylate. AJNR 7:919–925, 1986

    • Search Google Scholar
    • Export Citation
  • 27.

    Wilson CB, , U HS, & Domingue J: Microsurgical treatment of intracranial vascular malformations. J Neurosurg 51:446454, 1979 Wilson CB, U HS, Domingue J: Microsurgical treatment of intracranial vascular malformations. J Neurosurg 51:446–454, 1979

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 398 225 15
Full Text Views 306 13 1
PDF Downloads 81 8 2
EPUB Downloads 0 0 0